In this country they are so intersected. They confound. It’s hard to separate them. We know that the poverty rate for black people has historically been much higher than for whites, so it becomes hard to untangle them. The issue is complicated by the fact that we don’t collect data by incomes—at the [Centers for Disease Control], you have data by sex, age, region and exposure category. And ethnicity. You don’t have socio-economic status. That also becomes an artifact of reporting. People who go to private physicians to be tested are not going to be in the same pool for having that information reported as someone who gets tested at a city health center. There’s so much that we don’t know and don’t collect.
What’s the next step?
I think what we need to do is a syndemic approach, looking at prevalence of all these different conditions. One problem is focusing on solely as HIV as one thing. We need to make a much more comprehensive approach, integrating what we know about structural factors, housing and unemployment. That would have an impact for reducing HIV risk, and other health problems that plague low-income families, tuberculosis, other STDs. There are ways for us to be really creative as to how we improve health of communities as a whole across all of these different diseases. I think that’s really promising.